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General NPI Number Information
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NPI Number | 1164885109
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Entity Type | Individual
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Provider Name | MARSHAE ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 26300 OUTER DR
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City | LINCOLN PARK
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State | MI
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Zip | 48146-2019
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Country | US
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Telephone | 734-530-8697
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Fax |
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Provider Business Mailing Address
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Address Line | 16606 GREENVIEW AVE
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City | DETROIT
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State | MI
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Zip | 48219-4173
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Country | US
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Telephone | 313-471-8180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6802088621
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401017528
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License Number State | MI
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